The rate of port-site metastases after 2251 laparoscopic procedures in women with underlying malignant disease.
BACKGROUND
The aim was to describe the rate of laparoscopic trocar-related subcutaneous tumor implants in women with underlying malignant disease.


METHODS
An analysis of a prospective database of all patients undergoing transperitoneal laparoscopic procedures for malignant conditions performed by the gynecologic oncology service.


RESULTS
Between July 1991 and April 2007, laparoscopic procedures were performed in 1694 patients with a malignant intraabdominal condition and in 505 breast cancer patients undergoing risk-reducing, diagnostic or therapeutic laparoscopic procedures without intraabdominal disease. Port-site metastases were documented in 20 of 1694 patients (1.18%) who underwent laparoscopic procedures for a malignant intraabdominal condition. Of these, 15 patients had a diagnosis of epithelial ovarian or fallopian tube carcinoma, 2 had breast cancer, 2 had cervical cancer, and 1 had uterine cancer. Nineteen of 20 patients (95%) had simultaneous carcinomatosis or metastases to other sites at the time of port-site metastasis. Patients who developed port-site metastases within 7 months from the laparoscopic procedure had a median survival of 12 months whereas patients who developed port-site metastasis >7 months had a median survival of 37 months (P=0.004). No port-site recurrence was documented in patients undergoing risk-reducing, diagnostic or therapeutic laparoscopic procedures for breast cancer without intraabdominal disease.


CONCLUSIONS
The rate of port-site tumor implantation after laparoscopic procedures in women with malignant disease is low and almost always occurs in the setting of synchronous, advanced intraabdominal or distant metastatic disease. The presence of port-site implantation is a surrogate for advanced disease and should not be used as an argument against laparoscopic surgery in gynecologic malignancies.
Zivanovic
Oliver
O
Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Sonoda
Yukio
Y
Diaz
John P
JP
Levine
Douglas A
DA
Brown
Carol L
CL
Chi
Dennis S
DS
Barakat
Richard R
RR
Abu-Rustum
Nadeem R
NR
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology* / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D009366:Neoplasm Seeding